When a local pharmaceutical committee chair dared to suggest that some locums had been guilty of “unprofessional blackmail behaviour” in trying to secure increased rates, the backlash may have come as a shock to him. Or perhaps it didn’t, writes ICP editor Neil Trainis…

Amish Patel is a brash young independent community pharmacist; innovative, entrepreneurial, brimming with ideas. And he’s not afraid to say what he thinks.   

On April 1 this year, he was appointed chair of Kent LPC but it was no April Fools. The LPC meant business and when Amish, an independent prescriber who has boldly ventured into medical aesthetics and runs the award-winning Hodgson Pharmacy in Longfield, recently took to Twitter to talk about his experience of a minority of locums, he too meant business.

He wasn’t out to get anyone in trouble or shame any individual. He didn’t want to fan the intensifying flames of a social media debate on whether pharmacy closures were being caused by a shortage of pharmacists or an unwillingness on the part of some multiples to pay locums the rates they had agreed. He simply wanted to get a few things off his chest.   

I decided to contact Amish after he had tweeted during one thread that he had seen in “social media groups” some pharmacists saying things like “don’t book in advance” and “get paid a minimum £50 per hour.” He went on to describe that as “unprofessional blackmail behaviour.”

He had alluded to some locums apparently trying to back pharmacies into a corner by deliberately delaying their applications for a shift until a week or so before the start date when they would then contact that pharmacy with offers to work for more than the advertised rate – in the knowledge the pharmacy would not be able to open without a locum. 

When I asked him if he had personally experienced this behaviour, he said (in a personal capacity): “Fortunately, I can’t say I have experienced anything terrible. I have put shifts up to two months in advance and had no takers via the locum agency. Then one to two weeks before, I suddenly get counter offers for £5 to £10 per hour more." He claimed this started happening “more frequently since April.”

“I planned annual leave (on about June 7) for the end of August. I still had a shift available until (August 1). In some cases, I have called friends and asked them a favour to work for me. They would be my go-to usually but some live far and generally work in other pharmacy sectors now.

“So, where I am, I generally advertise £30 to £35 per hour. I have gone to £40 when it’s been short notice or when my wife was in hospital with complications following the birth of our daughter. But I have not gone above £40. Above that, I contact friends to ask a favour or my dad who is trying to retire. In the social media groups, the gist seems to be, ‘don’t book early, get £50 per hour’ and in some cases ‘get paid from opening even if you are starting two hours late.’”

Amish was philosophical about the situation and suggested pharmacists should get £50 per hour, but he also insisted that contractors cannot afford those rates because the funding isn’t there. He had some sympathy with locums but was also prepared to call some of them out.

“This behaviour of (some) locums will drive pharmacies to close, whether temporarily like Tesco, or out of business entirely. Its short-sighted. There needs to be better understanding and working together.

“Locums then comment on Twitter about working conditions. Something has to give. If you take emergency shifts which may even be part-way through a day, you will have to pick up the backlog. Simple. Or pharmacies will cut the costs of staff to afford the locum rate. Pharmacies cannot open without a pharmacist, so they will prioritise a pharmacist over other staff at the end of the day.”

Amish said that although he thought most locums were behaving properly, he found it “very infuriating” reading social media posts that apparently highlighted how other pharmacies “must be getting treated.”

There’s two sides to the argument

The price for speaking his mind, he claimed, was to be targeted by a few locums who belittled him and insulted him on Instagram as well as Twitter. The response was at times quite ferocious. Some questioned whether Amish was right to use “blackmail” to describe the alleged actions of some locums and some respondents engaged in the kind of keyboard warrior behaviour that makes us wonder what psychological effect Twitter in general can have on mild-mannered individuals.  

Nonetheless, the locum camp put forward some pretty strong arguments. One individual who has led the charge is Tohidul Islam who has criticised some multiples for closing branches and dismissed their claims of a workforce crisis.

He founded The Pharmacist Cooperative which says it’s the largest network for pharmacists in the UK, connecting locums to employers among other things. As a locum himself, one might think his staunch defence of locums comes as little surprise but he has made some persuasive points.    

He has accused multiples directly on Twitter of trying to get locums to reduce their rates and closing branches when they failed to do so. The Company Chemists' Association rejects this. And in a subtle dig at Amish’s claims, Tohidul said: “I’ve been speaking to a few co-ordinators across small to medium-sized pharmacy chains. The average rate is somewhere between £37 and £40 and none of them had to close. They all get responses when they advertise shifts.” He described the issue of locums’ rates as “a red herring.”

At one point, he challenged companies he believes are capping locum rates to open up a dialogue and talk constructively to find a resolution.

“If you’re honest enough to admit that there is no pharmacist shortage and the pharmacy closures are because companies don’t want to/can’t afford to pay higher rates, then let’s have an open, honest discussion about how we can work together to improve the situation,” he tweeted.

The issue of locum rates feeds into the wider debate of why pharmacies have closed. General Pharmaceutical Council chief executive Duncan Rudkin told Independent Community Pharmacist it was a “complex issue” but said the regulator would look into it. Yet it is difficult to see what the GPhC can do about it. As Duncan pointed out, pharmacy closures are more to do with financial and labour market-driven factors rather than regulatory ones.

Whatever side of the locum argument you come down on, the economic case is hard to ignore. The NPA vice-chair Nick Kaye was diplomatic as he tackled the issue in an opinion piece this month for ICP, suggesting that while locums should be paid the rates they ask for, owners are not in a position to meet their demands because of a community pharmacy contract that is “fundamentally underfunded.”

He said some locums he normally employs have increased their rates while those he has never used before are “more expensive.” Consequently, he said it felt “harder” to book locums than in the past where he practises in the south-west of England.

“For the business in Cornwall where I am a director, we use a number of regular locums and they have put their prices up and some of the newer locums to us are more expensive. Of course, I accept that we have to pay our locums the going rate and we value their professionalism and skill,” Nick said.

“The issue for owners is that the community pharmacy contract in England has not improved and right now it is fundamentally underfunded.”

He said he hoped locum rates as well as pay scales across the NHS are taken into consideration during the PSNC’s contract negotiations with the government. Indeed, PSNC chief executive Janet Morrison told ICP that the negotiator has been contacted by contractors of all sizes about the availability of pharmacists and “rapidly inflating locum rates.”

“My belief is that we should be looking at locum rates and the NHS-managed sector bandings to build into contract negotiations to improve the funding quantum and if that increases by retaining dispensing and growing clinical services, then community pharmacy will be the place where people want to practice,” Nick said.

Tohidul, however, did not seem to accept that inadequate funding through what he suggested was a “poor” contract was a reason for locums not being paid the going rate. “Although it is a poor contract, the issues we face as employees and locums started a long time ago but the multiples can’t cover it up anymore,” he tweeted.

Whatever your views are on closures, workforce shortages and locum rates, this is a debate that is set to run and run.

What are your thoughts and experiences? Email ICP editor Neil Trainis on neil.trainis@1530.com